Livedoid Vasculopathy: A Review of 5 Clinical Cases

Abstract

Livedoid vasculopathy is an unusual thrombo-occlusive dermatosis that manifests with punctiform erythemato-purpuric lesions and extremely painful ulcers, preferably in the lower third of the legs. We report five patients with livedoid vasculopathy, three men and two women, aged between 24 and 54 years, with no relevant personal background. The diagnosis was confirmed by biopsy in four cases. Study of thrombophilias revealed heterozygosity of the MTHFR gene in two cases. Treatment was diversified and included among others, venothropics, anticoagulants, antithrombotics, immunosuppressants and intravenous immunoglobulin. Only one patient has unsatisfactory control of the disease. Livedoid vasculopathy etiopathogenesis remains uncertain. It may occur in the context of hereditary or acquired thrombophilia, autoimmunity or neoplasms. These changes should be excluded, but most cases remain idiopathic, which contributes to the therapeutic difficulty. The authors intend to emphasize the importance of the Dermatologist in the diagnosis of a probably under-recognized disease that causes significant morbidity.